Therapy Sessions are Not Enough for Recovery

Rev. Sheri Heller, LCSW
Photo by Adrian Swancar on Unsplash

For over three decades the method of treatment I facilitate is similar to the type of therapy I engaged in throughout my recovery. Albeit, my entree into long-term therapy, although well-intentioned and ultimately reparative, did not contain Dr. Judith Herman’s theoretical framework for understanding complex trauma.

Nevertheless the core principles of establishing a strong therapeutic bond so as to embark on a journey of plumbing the depths of memory and subconscious motivations sustained me through the worst of times and serves as a blueprint for the treatment I now provide as a complex trauma therapist.

I consider treatment that consists of a psychodynamic methodology to be an inspiring holistic and potentially transformative path. Therapy that offers a deep comprehensive approach of mind, body, and spirit, and is inclusive of creative expression and eclectic techniques, proffers an effective trajectory to growth and reclamation. It is the antithesis of what is referred to as custodial maintenance, which primarily concerns itself with carrying out basic activities of daily living.

The foundation of psychodynamic work is the bond between the therapist and the client. The therapeutic alliance serves as an attachment template, which allows early life attachments and relationships to be consciously processed. This collaboration between the therapist and client is the driving force that sustains and supports a courageous embodied process of intra-psychic exploration and healing.

Deep excavation of one’s history and the processing of powerful emotions is fundamental to psychodynamic work. This challenging dive into one’s emotional world entails unearthing unconsciously repressed material. Profound self-exploration allows one to fully comprehend one’s defensive posturing and patterns of behavior so that intrinsic shifts can occur.

Yet as much as psychodynamic processing fosters healing and growth, what happens outside of sessions is often more critical to recovery than insightful epiphanies or even ‘breakthroughs’ that occur in therapy.

This is largely because in the aftermath of deep psychological excavation subconscious material continues to germinate and insights continue to be metabolized. How these realizations are sustained, encouraged or ‘forgotten’ or blocked determines either the attainment of milestones or ongoing stasis.

Likewise the sustained remission of addictive disorders is largely predicated on the resourcing that occurs outside of sessions.

Naturally, active addictions impede the efficacy of therapy. When one is medicating and acting out emotional material cannot be adequately processed. Making meaning out of one's pain and defining personal truths are obscured through mood-altering, whether it be with a person, a behavior or a substance. In short, the psychological underpinnings of addiction cannot be sufficiently addressed when intoxicated.

Although the fundamental aim of establishing sobriety is critical to healing and growth, achieving and maintaining sobriety is a formidable task. Cravings and triggers are inevitable especially in the early stages of abstinence. Hence, attending 12-step fellowship meetings, doing step work with a sponsor, and changing one’s lifestyle are necessary prerequisites to recovery. Utilizing resources when the threat of a slip or relapse occurs is critical to handling the challenges and stressors of ongoing sobriety. Designing a relapse prevention plan so as to identify the people, places and things that can trigger a relapse is also integral to staying sober. Those who attempt to simply ‘white knuckle’ it generally do not fare well, as one cannot will one’s addiction into remission.

Along with the aforementioned restorative measures necessary to achieving remission of addictive disorders, complex trauma recovery also necessitates the utilization of ancillary supports outside of the therapy office. The form of these collateral therapeutic tools may vary from person to person, but in order to create inner peace and strive towards wellness, the needs of the mind, body and spirit must be considered.

The domain of the mind concerns memories, emotions and the psyche, meaning the internal forces that impact personality and behavior. To enhance the client’s understanding of these internal forces and the issues being addressed in treatment I typically recommend that therapy clients engage in the mindful practice of bibliotherapy.

Samuel Crothers who coined the term bibliotherapy in 1916 imparted,

I don’t care whether a book is ancient or modern, whether it is English or German, whether it is in prose or verse, whether it is a history or a collection of essays, whether it is romantic or realistic. I only ask, “What is its therapeutic value?”

As Crothers suggests, when applied in a therapeutic context, fictional or non-fictional reading can enhance the treatment process. Non-fictional reading provides knowledge pertaining to a client’s condition so that a deeper mobilization of analysis ensues. Furthermore, the fictional terrain of fairy tales, comic books, and myths speaks of the metaphorical symbolism evident in the trials of heroes and heroines, who like the reader were challenged to persevere and triumph over the harsh reality of brutal malevolence and inconceivable circumstance. Reading these archetypal stories affirms our interconnectedness. It reminds us of the fundamental nature of our very existence and the universality of our shared humanity.

Writing too can be a powerful agent of therapeutic discovery. Crafting letters to address unresolved betrayals with folks who are deceased as well as alive, assists with gaining perspective of unresolved relational wounds.

Similarly, my collection of journals evidence how chronicling my daily struggles, fears and triumphs served as a consistent therapeutic aid. Keeping track of my inner and outer world through documenting thoughts, events and feelings, strengthened my recovery from complex trauma. It kept me connected to process and provided me with an abundance of material to explore in sessions.

Expressing one’s plight through prose or any artistic medium such as visual art, dance, film, photography, etc. is also a powerful practice. Art-making allows for deliberate arranging and re-arranging of symbolic elements lurking in the subconscious. This impacts one's total being, offering the possibility of discovering meaning and altering, or even transforming suffering. It also mobilizes what humanistic psychologist Abraham Maslow described as the birthright of the real self.

Shifting consciousness so that a more expansive meaningful perspective of life occurs, is galvanized by a consistent regimen of creative and spiritual exploration.
Photo by Sheri Heller / Kayenta Art Village, Ivins Utah

The immersion in spiritual, creative and philosophical teachings and practices organically leads the survivor of complex trauma towards challenging nihilistic and fatalistic assumptions about the self and the world. Over time this commitment to the expression of one's true self establishes a trajectory towards the transpersonal, or what is beyond the limits of the personal self. It guides one towards giving life to a perspective that makes room for the existence of faith and hope.

By routinely putting faith in transcendent realities and the benefits of practices that align with the abstract, the desire for life-affirming change is inevitable. Hence, a heightened interest in improving relational patterns and experiencing more satisfying relationships is likely to occur. The revived impulse to alter ways of being with family, friends and colleagues requires putting effort into defining self-protective limits and boundaries and cultivating discernment and discrimination.

Exercising new behaviors and ways of expressing oneself with others may involve traveling, taking classes, dating, volunteering, changing one’s residence, or transitioning to a new job. All these risks put the microcosm of therapy to the test in the real world.

Along with mind-spirit disciplines, another integral part of recovery is learning how to modulate and access the body’s wisdom. This translates into identifying what visceral sensations correspond with specific feelings, along with devising methods to elevate the mood and regulate the parasympathetic nervous system.

Ancillary supports, such as yoga, martial arts, somatic experiencing, massage and energy work assist with aligning with the body’s wisdom so that what is signified through physical symptoms can be interpreted. Understanding the deeper implications of headaches, body tension, clenching hands or feet, or grinding teeth calls for a discipline of grounding.

Discerning one’s center through grounding allows one to consciously scan and observe the body’s repository of sensorial communication. Coupling this form of self-care with exercise serves to inhibit the production of adrenal hormones and encourage the production of endorphins and other neurotransmitters such as dopamine and serotonin. Likewise, sufficient rest and solitude reduces cortisol levels and returns one to a state of homeostasis.

For many whose symptoms are not adequately assuaged by their efforts with personal maintenance, psychotropic medication management is a viable option.

Essentially, in order to maximize the impact of therapy the willingness to continue the work outside of sessions is critical. The range of exploration and discovery is vast and can indeed be arduous, especially when the gravitational pull of depression and hopelessness kicks in. That one’s life should be defined by a disciplined path of recovery can feel like a staggering responsibility, especially when sundry efforts are not mitigating the prevalence of emotional flooding and dissociation.

Suffice it to say recovery is extremely hard work. My clients who progress are diligent with attending therapeutic workshops. They partake in bodywork, socialize, exercise self-care, participate in pet therapy, devote themselves to activism, explore their creative and spiritual expression, engage in group therapy, incorporate EMDR and DBT into their recovery, revisit their familial home where the abuse occurred, create an altar, review childhood photos, etc. Basically, they are willing to do whatever it takes to facilitate healing. They know that although weekly therapy sessions alone are a serious commitment, it is simply not enough to facilitate steadfast change.

In hindsight, the only way I managed to stay the course was by hobbling together a routine outside of therapy sessions that consisted of twelve-step groups, bodywork, and John Bradshaw’s inner child work. Along with my immersion in the arts, academia and my love of travel, these modalities helped me manage debilitating symptoms and define a historical narrative.

Slowly these efforts allowed me to glean a distinct awareness of myself. Decades of intensive trauma therapy, workshops, academic pursuits, gainful employment, and global travel eventually led towards my reclaiming an authentic embodied self. Remaining persistent, until symptoms would subside not just momentarily, but for extensive periods of time often seemed like an exercise in futility. There were times when in spite of all I carried out the pain of my existence made it all seem pointless. Still, the instinct of self-preservation kept me going.

For those of us who pressed on and finally gleaned the rewards from tireless attempts to heal and thrive, it becomes undeniably clear that it was worth the years of perseverance, effort and struggle. Indeed, it makes me grateful to look back and know I made it through. Most of all I am humbled to be able to pass on this message of hope to those who with legitimate trepidation, are willing to responsibly and bravely take on this plight.

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As a survivor (and thriver) of complex trauma and a seasoned therapist specializing in treating complex trauma, narcissistic abuse syndrome and addictions, I am intent on creating content that affords informative insight, hope and healing from psychological disorders. I aim for my creative content to assist readers with tapping into the resiliency of the human condition while recognizing the countless challenges of being human.

New York City, NY

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